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When your vagina isn't properly lubricated, it can feel itchy and irritated. Vaginal dryness can make daily activities uncomfortable and sexual intercourse less pleasurable. In fact, it's the primary cause of painful sex (dyspareunia). Vaginal dryness is a common problem that affects women of all ages, but there are effective treatments.

Vaginal dryness is caused by a number of conditions and can be either an occasional hassle or a chronic problem. Determining the cause of your vaginal dryness can help you find an appropriate solution.

Estrogen levels

A decrease in estrogen level is the main cause of vaginal dryness. When your estrogen levels decrease, the amount of vaginal lubrication you produce also drops. Decreased amounts of estrogen also lead to a thinner, less elastic and more fragile vaginal lining. Estrogen levels fall for many reasons, including:

• Menopause and postmenopause
• Surgical removal of your uterus or both ovaries
• Breast-feeding
• Conditions that cause your ovaries to release reduced amounts of hormones, such as anorexia, exercise-induced amenorrhea and hypothalamic amenorrhea
• Drops in estrogen level before and after your menstrual period
• Chemotherapy
• Birth control methods including pills, shots and implants

Some medications — such as tamoxifen (Nolvadex) and raloxifene (Evista) — interfere with the estrogen activity in your body, resulting in vaginal dryness. In addition, allergy medications, such as antihistamines, can dry out your mucous membranes, including those in the vaginal wall. Ulcer, antidepressant and high blood pressure medications also can lead to dryness of your vaginal tissues.

Sjogren's syndrome

This is an autoimmune disease in which your immune system attacks healthy tissue. In addition to causing symptoms such as dry eyes and mouth, it can also decrease moisture in your vagina.

Douching

This process of cleansing your vagina with a liquid preparation disrupts the normal chemical balance in your vagina and can cause inflammation (vaginitis). This can cause your vagina to feel dry.

Since loss of estrogen is the main cause of vaginal dryness, it's not surprising that estrogen replacement therapy is often an effective treatment. Options include:

• Vaginal estrogen cream (Premarin, Estrace, others). Insert the cream into your vagina with an applicator 2 or 3 times a week.

• Skin (transdermal) patches containing estrogen (Alora, Climara, others). Apply a patch to your skin and wear it from several days to a week at a time.

• Vaginal estrogen rings (Estring). You or your doctor inserts the soft, plastic ring into the upper part of your vagina. The ring releases estrogen over a period of 90 days.

• Vaginal estrogen tablets (Vagifem). Use a disposable applicator to place a tablet in your vagina on a regular basis — every day for the first 2 weeks and then twice a week.

• Oral hormone supplements. Take these pills on a daily basis. Both the combined estrogen and progesterone pills and estrogen-only forms are effective.

All of these methods increase the amount of estrogen in your vagina and will relieve vaginal dryness for as long as you use them. Talk to your doctor to decide if estrogen treatment is an option and, if so, which type will work best for you.

If vaginal dryness makes sexual intercourse painful, a number of over-the-counter remedies are available.

• Lubricants (Astroglide, Lubrin, K-Y Jelly). Water-based lubricants work to lubricate the vagina for several hours. Insert the lubricant into your vagina before intercourse. Applying lubricant to your partner's penis may also help.

• Moisturizers (Replens, K-Y Long Lasting). Vaginal moisturizers act on the vaginal tissue and may decrease dryness for more than 1 day with a single application. Moisturizers generally have a low pH that maintains the acidic environment in the vagina and may decrease infections.

If you find that you have occasional vaginal dryness during intercourse, it may be that you aren't sufficiently aroused. Instead of rushing into sex, make time to be intimate with your partner and allow your body to become adequately aroused and lubricated. It may help to talk with your partner about what feels good for you. Also, having intercourse regularly may help promote better vaginal lubrication.

There may be items that you can add to your diet to help increase moisture in your vagina.

• Isoflavones. Isoflavones (plant estrogens) are compounds found in soybeans, soy products and red clover that can produce a weak estrogen-like effect. Researchers believe that soy products might help with vaginal dryness, though there's insufficient data to say for sure and the best sources of isoflavones and specific amounts to take haven't been determined.

• Black cohosh. Black cohosh (Cimicifuga racemosa), also called black snakeroot and bugbane, is a plant that is purported to reduce some symptoms of menopause, including vaginal dryness. Some clinical studies have supported these claims, though their validity has been questioned. Don't use black cohosh for longer than 6 months, and don't use it in combination with estrogen replacement therapy, hormone replacement therapy or antihypertensive medications.

Make sure that you drink enough water. Until your body is properly hydrated, it will lack the resources to keep your vaginal tissue lubricated. If your urine is dark yellow and has a strong odor, or if you go to the bathroom fewer than four times a day, you may need to increase your water intake.

Though you may be willing to try just about anything to relieve your discomfort, avoid using these products to treat vaginal dryness, as they may irritate your vagina:

• Vinegar or other douches.
• Yogurt or cultures of lactobacilli.
• Hand lotions.
• Soaps.
• Bubble baths.
• Bath oils.
• Oil-based products, such as petroleum jelly and baby oil. One exception is vitamin E, which may provide lubrication and relieve itching and irritation.

By Mayo Clinic staff

WO00034

July 23, 2002

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